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FOR OFFICE USE: a-z APPLICATION FOR SANITATION PERMIT r� -------------------------- / - p p . Permit No. (Complete in Triplicate) ---------=-- - ------------------------------------------ p Date issued ,j---�'--�� --_------_---------------------- This Permit Expires 1 Year Froen'Date Issued w\ - Application is hereby made to the San Joaquin Local Health District for al per to construct and install the work herein described. This application is made in compliance with County OrdinancelNo. 349 and existing Rules and Regulations: - Q 4 _ �_!� / .CENSUS TRACT ------- ' JOB ADDRESS/LOCATIO � ------- - ----- --.----- ----- -- + - -- - - - -��- ----- - ---�---' .- q Owner's Name _____- ---Phone?Mg-------- Address ----------------- s /'-------- t--------------------------• City ------------------ �� Contractor's Name __- ._ _.License #1 �-,--- -- Pho a .� -6-- --T�-•-- Installation will serve. sidence Apartment House❑ Commercial ❑Trailer Court-:E] Motel ❑Other �'/'�- --- R-.` 1 r Number of living units:.-.--�____ NumberTof bedrooms _ ____Garbage Grinder __[---_�..Lot Size 12-19___X - Water Supply: Public System and name --------------------- -- -------------------------------•-- �'`'-- ---- ---•- Private UA Character of soil to a depth of 3 feet: Sand' ❑ Silt❑ Gay, E] Pedt❑ Sandy Loo ?m,. � Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material ------ If yes, type ______________________--___ (Plot plan, showing size of lot, location of� system 'in�relationttaawell s,•buildings, etc. must be,placed ion reverse side.) * - NEW INSTALLATION: (No septic tank or seepage pit permitted if pubfilic.sewer is available within 200 feet,) lie u , I w r `, SEPTIC TANK' f�S- e-----�` - _ Liquid Depth _____--___--------------- PACKAGE TREATMENT { ] !-{ )-___"__-_- I i. _ - -- -Capacity _ Type - ----_-_-- -k. :__ Mdterral '-- No. Compartments ---------------------- Distance to nearest: Well -----------15;2)------ ____Foundation __._ Q____t" Prop. Line ________ Q� i LEACHING LINE No. of Lines __S__3______________ Length of each line__ Q__-------____ Total Length ---_2-149-----__-__.. 1 -f 'D'-Box ------------Type Filter-Material _IhG� ---4--Depth Filter Material -----��--- ------ --------------•"-•- Distance to nearest: Well ---<-4'_---- Foundation ------LD-_�'-7------ Property Line .5-71 -_-------- SEEPAGE PIT'"[-1—Depth --- Diameter' ---------------- Number ------`------.------------- flock Filled Yes ❑ No i❑ Water Table Depth hock Size :S Distance to nearest-. Well ----------------------------------------Foundation ---_---------------- Prop. the _....--- =----- REPAK/ADDITON(Prev. Sanitation Permit# ------------------------------------------- Date ----------- _ _--------.__-----) 1 SepticTank (Specify Requirements) ------------------ ---------------------------------------------------------------------------------------.----------------------------- Disposal Field (Specify Requirements) _____________ � r + -- -------------- -: - ----------------------------------------------------------------------------------- ------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that-the work-will-be•done'-in-accordance-'- Ith•Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District."Homo owner or licen- sed agents signature certifies the following: I "f "I certify that in the performance of the work for which this o ermit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." + Signed --------- Owner. j - ----- ' By --- -------- --- -- - -------- ---I----- 4. - r � I le -------- Title r (If other n owner) I " r , � f FOR DEPARTMENT USE ONLY APP(_ICATION ACCEPTED BY ------- 0 - -- ---- -------- -------------------------- - -------------------- DATE ---- -3 `'--`:------ BUILDING PERMIT ISSUED' ------- ----------- - ATE 4 ADDITIONAL COMMENTS[_._=5`'�- -_�� __ _�_`�r` �'_ -= ,�U _-_.. = �->Q- �c [•3,r _a,� 'ar_�_.t- ✓atr�f__.n .: -- '---------------------------------------------- g - ----- -------------- t + ------------------------------------------------ ------- ----------------=----- ----------- FinaFl Inspection by: ...... +— -------------------------------------------------- ---------------------- ---- Date yn -------------:---------- SAN JO.AQU.N-LOCAL-HEALTH_DISTRICT— _. R.� E. H. 9 1-'68 Rev. 5M i�